Osteoradionecrosis (ORN) of the mandible is a rare complication of radiation therapy for head and neck cancer. It manifests as an area of exposed necrotic bone failing to heal for at least 3 months. Our study aims to determine the effectiveness of HBO in management of radiation induced mandibular ORN. A retrospective study of 33 subjects of mandibular ORN treated with HBOT during period 2009-2011 was carried out. The mean patient age was 60 years (range 41-80).They were treated in a multiplace hyperbaric chamber at 2.4 ATA, for 90 min once a day for up to 30 sessions. Pre and post treatment improvement in relation to symptoms, healing of intraoral wound and overall wellbeing were evaluated. Out of 33 Subjects, 48 % (n = 16) cases showed complete healing of wound, 18 % (n = 6) had marked healing, slight healing in 24 % (n = 8) cases and 9 % (n = 3) cases had no change in healing. 70 % (23 of 33) cases had significant reduction in pain, 62 % (18 of 29) cases had improved jaw opening, 41 % (11 of 27) cases and 71 % (20 of 28) cases showed improvement in ability to talk and mouth dryness respectively. Overall 85 % (28 of 30) cases showed improvement. Our clinical experience supports the efficacy of HBO treatment for radiation induced mandibular ORN and we recommend additional multicentric, prospective studies to be carried out defining the role of HBOT using at least 30 sessions in such cases.

Aim: Comparison of the integral dose (ID) delivered to organs at risk (OAR), non-target body and target body by using different techniques of craniospinal irradiation (CSI). Materials and methods: Ten CSI patients (medulloblastoma) already planned and treated either with linear accelerator three-dimensional conformal radiation therapy (Linac-3DCRT) technique or with linear accelerator RapidArc (Linac-RapidArc) technique by Novalis-Tx Linac machine have been analysed. Retrospectively, these patients are again planned on Radixact-X9 Linac with Helical, Direct-3DCRT and Direct-intensity-modulated radiation therapy (Direct-IMRT) techniques. The dose prescription to planning target volume brain (PTV-Brain) and PTV-Spine is 36 Gy in 20 fractions and is kept the same for all techniques. The target body, non-target body, OARs and total body dose are compared. Results: ID is lowest in the RapidArc plan for every patient in comparison to Helical and Direct-IMRT. The ID for Body-PTV was found slightly higher in the RapidArc plan in comparison to 3DCRT plans. But there is better normal tissue sparing for most of the OARs in RapidArc plans if it compares with 3DCRT plans. Findings: RapidArc is a better alternative for the treatment of CSI. It provides better target coverage and better OARs sparing from any other treatment techniques.

Introduction: The method of radiotherapy has moved away from two-dimensional and three-dimensional conformal radiotherapy towards Volumetric-Modulated Arc Therapy (VMAT) for advanced carcinomas. VMAT treatments often result in significant clinical advantage, particularly when concave dose distributions are required as is often the situation since these tumours are in close proximity to several critical structures. Aim:To investigate the potential clinical role of volumetric arc therapy on cervical cancer patients and its comparison with fixed-field Intensity-Modulated Radiotherapy (IMRT) was used as a benchmark. Materials and Methods: Retrospectively, radiotherapy treatment plans of fifteen cervical cancer patients were selected for this study. These patients were previously treated with sliding window IMRT techniques during January 2020 to November 2020. For dosimetric comparison of sliding window IMRT techniques with RapidArc, a new set of plans were created using VMAT/RapidArc technique. For each patient two plans were generated and in this way total 30 plans were analysed. The prescription dose to Planning Target Volume (PTV) was 50.4 Gy in 28 fractions (1.8Gy/fraction) for the 6 MV photon beam. Comparison of each plan done on the basis of Organs At Risk (OARs) sparing, coverage index (C), Conformity Index (CI), Homogeneity Index (HI), dose Gradient Index (GI), and Unified Dosimetry Index (UDI). This study utilised UDI scoring for evaluation and comparison of RapidArc and IMRT plans. Treatment Time (TT) for patient comfort and the number of Monitor Units (MUs) for long-term side-effects was also taken into consideration. A paired two-tailed t-test was executed for the dosimetric study of volumetric arc modulation with RapidArc and its comparison with the IMRT technique in the radiotherapy treatment of cervical cancer patients. All the collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. The (p-value<0.05) was contemplated for the level of statistical significance. Results: Comparable target coverage and better sparing of OARs were achieved with the RapidArc technique in comparison to IMRT. As was evident with results of present study, the values of CI (1.55±0.07), HI (1.07±0.07), GI (0.98±0.01) and UDI (1.25±0.11) of RapidArc technique showed significant difference from respective values of IMRT Technique (1.67±0.06, 1.10±0.06, 0.96±0.01 and 1.38±0.13). Values of MUs (1560.47±52.16) and treatment time (3.71±0.73 mins) were significantlly high in IMRT technique as compared to RapidArc technique (542.33±51.09 and 2.39±0.35 mins respectively). Conclusion: From this study, it is clear that a similar planning goal can be achieved by RapidArc in comparison to fixed-field IMRT with less normal organ toxicity. RapidArc is a faster and precise treatment technique. The most significant change comes to see in the number of MUs and TT, which is much lesser in RapidArc.

Most common lymphatic spread of carcinoma breast is ipsilateral axiilary lymph nodes, internal mammary lymph nodes and supraclavicular lymph nodes. Inguinal lymph nodes involvement in carcinoma breast is quite uncommon. Surgery and irradiation for breast cancer may interfere with conventional pathways of spread, leading to bizarre patterns of dissemination through lymphatics or through hematogenous route. Other possible reasons could be occurrence of primary breast cancer in accessory breast tissue retained in the vulva following involution of milk line. We describe a case of right breast carcinoma who developed right ingquinql lymph node mets, brain mets after one month of neoadjuvant chemotherapy and mastectomy.